There is no law that can contain euthanasia - especially if the criteria is eliminating suffering

In November last year I attended a debate in Brussells between my Canadian colleague, Alex Schadenberg and two leading Belgian pro-euthanasia academics.

As I reported at the time, the comments made by Professor Etienne Vermeersch in not only defending the Belgian laws but also in arguing that there was 'not enough euthanasia' in his country left many of us speechless. Vermeersch was very clear: his aim to eliminate all suffering is a program of eliminating all sufferers. His observation that 'not enough euthanasia' deaths were occurring followed by a pointed attack on an audience member where Vermeersch said, 'Wait until you are paralyzed' said it all.

No-one wants to suffer and no-one wishes suffering upon another. This point, at least, we can say that we share with Vermeersch. But once we make the elimination of suffering the criteria for killing people were spinning out of control in a vortex that has only one logical conclusion: totally unfettered and unregulated euthanasia - with or without request.We should be wary of accepting the opinion of one academic to draw such a calamitous conclusion. But Vermeersch's words are also supported by what has occurred and what continues to occur in his country.

One recent example of what we could call 'euthanasia anarchy' should send shivers down the spines of any thoughtful observer. An official recent statement from the Belgian Society of Intensive Care Medicine boldly asserted that doctors need to be able to give lethal injections to shorten lives which are no longer worth living, even if the patients have not given their consent.

The Society has decided (decreed may be a better word) that it is acceptable medical practice to euthanase patients in critical care who do not appear to have long to live -- even if they are not suffering, even if they are not elderly, even if their relatives have not requested it, even if they have not requested it and even if it is not legal.

The Society spells out its policy very carefully. It is not about grey areas like withdrawing burdensome or futile treatment or balancing pain relief against shortening a patient's life. It clearly states that "shortening the dying process by administering sedatives beyond what is needed for patient comfort can be not only acceptable but in many cases desirable"."Shortening the dying process" is a euphemism for administering a lethal injection.

Most dying patients in intensive care have not made advance directives and "are usually not in a position to request euthanasia". Therefore, "difficulty can arise when the purpose of the drugs used for comfort and pain relief in end-of-life management is misconstrued as deliberate use to speed the dying process." The Society's solution to this difficulty is to allow its members to kill the patients.

Note Bene: Belgian law does not support such behaviour, but it is likely, in a country that recently supported euthanasia for children, that this is being received by the Belgian populous with little more than a passing thought.

And for those who might be tempted to find solace in the thought that euthanasia laws might somehow protect vulnerable people, think again: This behaviour shows up the recent intense parliamentary debate on child euthanasia in Belgium as the sham that it really always was.

Whilst the law makers deliberated over euthanasia for children, including so-called safeguards, the medicos themselves have said, in very clear terms, that the law - regardless of what it does and does not allow - is redundant; that they and they alone will decide who lives and who dies. The statement is, by the way, inclusive of euthanasia for children in the same terms.

This kind of thinking, that the doctors are the prime (if not sole) moral agents and ethical guides in determining who should die by euthanasia, is quite common. We first saw a public expression of this kind of development in 2004/5 in The Netherlands with the advent of the Groningen Protocol which allows for the euthanasia of disabled neonates. This remains, as it was then, outside the parameters of the Dutch law. As a postscript, the Dutch Medical Association said in 2013 that 'parental suffering' was a sufficient reason for infant euthanasia, even in circumstances where the child might not actually be suffering.

An exception to the criminal code that allows for killing of another person in expressed limited circumstances and for limited reasons will still mean that any killing outside those stated exceptions is a criminal offence under the laws on homicide. Or at least it should be. But what actually happens when a doctor does kill outside the law provides another potent example of why euthanasia law can never be contained.

In Belgium responsibility for assessing euthanasia cases rests with the Federal Control and Assessment Commission, chaired by Dr Wim Distelmanns. A 2007 study of euthanasia deaths found that nearly half of cases in the Flanders region were not even reported to this commission; something that should have created significant disquiet. After all, if all a doctor needed to do to hide a euthanasia death that he or she suspected was outside the law was not to submit the paperwork, then the work of the commission is effectively neutered. Nothing has been done to address this situation; the law is being ignored and everyone knows it.

Moreover, Distelmanns himself has been involved in a number of deaths that have come to the attention of international media where, on any reasonable assessment, there were at least sound reasons to believe that the law had been ignored. None of these cases was referred by the commission to the authorities for further investigation. In fact, no cases in the 12 years of the operation of the law, have ever been seriously questioned.

This idea that the law should simply get out of the way and allow for doctors to perform euthanasia deaths without review or accountability was driven home during an interview conducted for De Standaard in which Distelmanns and his friend Dr Marc Cosyns discussed the issue at some length. Cosyns candidly talks to both Distelmanns and the newspaper about his attitude to reporting: "No, not when it comes to our own patients," Dr Cosyns responded. "Everything I do is done on the basis of the law of patients' rights. We should not be required to give assurances that we did not intend to harm the person. Euthanasia is a normal medical procedure, as normal as the possibility of palliative sedation."

In that same interview, Distelmanns replies: "But Marc," he said gently, "you cannot ignore the criminal law."

A public acknowledgement of law breaking - even if only to the extent that Cosyns does not fill in the paperwork - and nothing is done; not by Distelmanns himself - who must have some obligation to the law because of his position on the commission - and not by law enforcement agencies.

The elimination of suffering has moved beyond a guiding tenet and raison détre for the law to being the sole determinant that absolves anyone who kills for supposedly compassionate reasons.

Even compassion itself seems to take a back seat here. While it remains an appropriate sentiment towards those who are suffering, like any emotion, any action that arises in us as a result of a sense of compassion is not only individual in character but must also be tempered by reason. If this were not so, then any action - no matter whether effective, appropriate or even legal - could not be judged on an objective basis.

If the law, public policy and/or medical guidelines do not and cannot create in the minds of doctors a sense of pause and opportunity to reflect on such situations before acting, then 'euthanasia anarchy' reigns in an increasingly dystopian and dangerous place to find oneself in need of medical attention.